B8 - Sunday, September 2, 1984 - North Shore News “It is noteworthy that in spite of on-going restraint issues we provide not only top quality of care but continue to do so with a future onented perspective that seeks tu take advantage of new understanding, technology and the benefit of experience which often requires new and innovative approaches ” Werner J. Pankratz. M.D. Chief of Medical Staff LGH welcomes its interns and is delighted to take an active part in producing quality physicians for the Canadian health care system. After a wait of almost 10 years for the necessary funding, LGH has a teaching program and 12 interns from across Canada who will spend a year rotating through different areas of the hospital: obstetrics and gynacology, pediatrics, medicine, laboratories, imaging services, surgery, medical day centre, extended care and psychiatry. All have completed at least three years of pre-medical preparation and four years of medical school and will enter general practice or go on to specialized training follow. ing their year at LGH. The Front Lines “Equipment and procedures known only to the largest refer ral hospitals a few years ago are commonplace in today’s community hospitals.” Dr. R. Puddicombe President of Medical Staff Hospitals are on the front lines of this battle. The hospital is, as tt has always been, a pivotal point of the health care system in the community. But it has become necessary to redefine and refine its mode of delivery In the 50s, many problems were dealt with by doctors making house calls. Admisstons to hospitals were often for longer periods of time than deemed necessary today -- maternity cases for up to two weeks, coronaries kept in bed for six weeks. Patients “under pressure” were admitted for periods of rest and overflow beds lined the corridors The 60s were the golden age of hospital expansion when everything was going to be bigger and better and new hospitals sprang up and older ones grew larger By the 70s reality started to set in and a period of contrac tion and solidification began. It was decided to try to bring the number of hospital beds tn BC down from 5 3 beds per thousand people to 3.2 beds This meant that beds would not be available to everyone but only to the acutely ill In the 80s, restraint is here to stay and hospitals must become more sophisticated and complex in order to cope with restricted funds and the intense lev® of Care now re quired of them Many cases that might have been seen at home 30 years ago now turn up in Emergency are treated and leave without being admitted as inpatients The contrac tion of the number of hospital beds makes this necessary, the advanced technology and equipment available makes it possible The inpatient population of the hospital Consists of only the acutely Hl often requiring one On One round the chook Nursing care Restramt nits the resources available to the hospital ret the demands placed on it) The expenses at lb abt ine rease each year because the workload increases Two years age the hospital admitted about 1.4.41 patients a month for an occupancy rate of 89 percent By the end of March LOH 4 with a reduction of 55 beds and 144 staff the bosptutal was Funning at about 1.316 patients a rm mithy fear cary coe Lap ane y rate of 91 percent Thts year’s budget allocation trom the Ministy of Health ot $45,088,671 would have been tosufflcient to Continue the level of services provided by | G1 last year |ortunately a surplus of funds accumulated tn anticipation of a higher wage settlement will make tt possible to maintain that level for this fiscal year. To continue to meet the increasing demands of the community for health care means that an operation as vast and complex as a hospital must be as finely tuned and closely monitored as an intricate instrument Hospital administrators have to juggle the needs of the community and the promises of the new technology with the day-to-day realities of financial constraint. The financial pressure emphasizes innovative delivery modes such as ambulatory care. LGH’s pioneering work has served it well in this area. For several years the hospital has pursued a philosophy of creating alternatives to inpatient care. The programs at the LGH Medical Day Centre, the first such centre in a Canadian hospital when it opened in 1979, provides an alternative to inpatient care for some patients and shortens the stay in hospital for others who can be dis charged and attend programs at the Centre Day Care surgery, where the patient is not admitted to the hospital ovemight but returns home a few hours after surgery, con tinues to show dramatic increases In the past year, 6,142 patients have had same day surgery, compared to 4,988 pa tients tn a 12 month period in 1983 The majority of these day surgery patients would have spent two or three days tn hospital in “the old days” Medical Day Centre provides self-help teaching for diabetic youths Fine Tuning the System “Health care professionals have never had to say “no” As the demands increased, we met them. Now where do we draw the line?” John Borthwick LGH Administrator The hospital continues to seek ways to concentrate and focus the limited available dollars in the area of paramount importance — the delivery of excellent health care services to the community. The process involves continual monitoring and assessment, tightening up the systems that keep the hospital running, cutting back in some areas, investing in others. It is a process of ongoing fine tuning. New possibilities in ambulatory and home care are being explored. One such is a highly successful pilot project that may lead to a new program at the hospital. Selected coronary patients who met certain criteria were sent home within five days of their heart attacks. They received home visits fro; trained cardiac nurse specialists and eventually enroll day programs at the Medical Day Centre. The progress of these patients was as favourable as that of the coronary pa- tients who remained in hospital twice as long undergoing conventional treatment. The project benefitted both the pa- tients, who were able to take up the reins of their lives much more quickly, and the hospital, by freeing up badly needed acute care beds. A request for approval and funds to estab- lish the program at LGH is before the Ministry of Health now. It would be a pioneer step in furthering the scope of ambulatory care and the integration of the health care facili- ties and the community. “We must direct ourselves no longer to 24 hour Cadillac type treatment but more efficient Chevrolet-type delivery such as the Medical Day Centre ” Dr R_ Bell Irving Director of Medical Day Centre Efficient delivery of health services requires an efficient plant and support services system. Fine tuning and moni toring in this area ensures that dwindling resources continue to be focussed on maximizing“health care services. In some cases this means rearranging existing resources-such as re scheduling laundry workdays to avoid “super stat” holiday¢ such as Christmas Day that require triple pay It also meant investing this year in a computerized energy management program An IBM central processing unit and seven DSC 8500 Smart micro computers watch and regulate the “weather” inside the hospital The computerized system allows the maintenance department to monitor all the air handling systems tn the hospital on a 24 hour basts and con trol temperatures to a fine degree Trends can be analyzed and needs predicted and programmed into the computer to provide still finer Control Inventory control and preventative maintenance manage ment can also be controlled through the same computer system The $115,000 cost of the computerised system has already been offset by the savings in energy and the more ef fient) preventative maintenance of expensive equipment such as heart monitors Computer programs have become as much a part of hospttal operation as budget restraints LGGH established the first building block of tts Computer system last year when thy hospital's accounting functions and the Patient Registration and Admissions Discharges were computerized Hundreds of thousands of file folders of pahent records in inpatient ser vices day care surgery and outpatient services such as rehabtiitation medical day centre and | mergency have now been Coordinated Pach LOH patent is assiqned a medical record number for Ite and all information on that patient can be located rapidly and reviewed and updated at any time The efficreney ot this syster means easter access ta vital information less documentation when dealing with patents on repeat visits and Tighter control of tilling procedures Now that a base has been latd the: fe »spital wall bein te move towards computenzed operational and patient «are systems The first step will toe ann cmedet etritry system ter can trol bed census information and tetany orders direc th tran Hupsiivg stations A program will also be set up to cmomitor the surgical wa lfinyg fist By momdtoring analy zing ane Pepmortinig: con aspects of the waiting list such as type of patient nature of operation length of waiting time eto oa better balanced ase of the operating factlittes can be matntained The increase in eastlh accessible invformation core ering both the hospital and the Community if serves is a valuable tool for administrators as they struggle to balance the needs of the Community and the resources avatlable to the hospital The Social Contract In Canada, we are committed to the tenet that everyone has the right to good health care: that no one should be denied treatment. The companion ot this statement is that we also have the responsibility to care for ourselves in a man- ner that will provide us with the best chance for maintaining good health. _ Unfortunately, many health problems are self-inflicted and could be prevented — they are diseases of lifestyle brought on by overindulgence in eating, smoking, drinking. The movement in the last few years towards a greater awareness of the importance of exercise and nutrition and the harmful effects of the abuse of alcohol, drugs and tobac- co is encouraging. The growing acceptance of seatbelts and child care restraints and the interest in working environments also reflect an increasing sense of responsibility for pro- moting good health and avoiding the need for treatment. However, a great deal more should be done to promote this sense of responsibility for achieving and maintaining good health. A federal government report in the early 1970s entitled “New Perspectives on Health for Canadians” recom- mended that community hospitals become the launching pads for health promotion in the community. But funding has not followed this recommendation — 95 cents of every health dollar is still directed towards treatment and only five cents towards prevention. Hospitals should be able to reach out into their community and help people learn how to stay healthy, but their budgets are allocated for “repair” and do not embrace the concept of prevention. Lions Gate Hospital has tried to incorporate the philosophy of preventative medicine by offering patient education programs through the Medical Day Centre Pro grams on diet counselling, diabetes, chronic obstructive lung diseases and care of the back are all highly successful The waiting list for these and other programs emphasizes the need and desire of members of the community to be given the tools to take responsibility for thetr own state of health The future holds a challenge Members of our community expect a continuing high quality of available health care ser vices and the health care professtonals are determined to continue to provide it The three sided dilemma of an aging population, tncreas ing expensive technology and diminishing financial resources will not disappear The North Shore community has always supported and participated in L.GGH's efforts to provide qual ty health care Volunteers are generous with thetr time, dona tions help purchase needed equipment and innovative pro grams are accepted and supported The continuation of this support and involvement of the North Shore community with its hospital is a promise that will help to balance the challenge of the future Cardiac exercise claas B9 - Sunday, September 2, 1984 - North Shore News —_ “Although we function in an increasingly technical world, our hope is that we still are offering humane compassionate service We are proud that this is LGH’s reputation.” Dr. W.J. Corbett Medical Coordinator Assist and comfort It would be impossible to imagine LGH without the Aux- iliary. From its formation in 1921 with 26 members, its membership has grown to almost 500 dedicated volunteers, plus more than 100 young Candystripers. Auxiliary members can be found in more than 20 different areas of the hospital as they pursue their founding objective: “to assist in the func- tioning of the hospital and add to the comfoft of the patients.” In addition to their gift of time and compassion, the Aux- iliary to LGH last year donated $58,083 to the hospital for equipment. Evergreen House grows The long awaited, much needed 125-bed expansion of Evergreen House extended care residence was open in April. Both residents and staff are pleased with the bright, open comfortable environment. The surrounding grounds are landscaped for wheelchair use and large sundecks and patios and a greenhouse enable the residents to enjoy the outdoors. Evergreen House has 294 residents with an average age of 84. Volunteers from the Auxiliary to LGH and a number of community organizations and Evergreen House’s one-to-one volunteer program help the residents maintain their integra- tion with the North Shore community. Board of Directors of the North and West Vancouver Hospital Society 1983/84 ELECTED OFFICERS Municipality of City of West Vancouver North Vancouver [> Brousson D. Burbidge KC Bruce S Simpson Hi Clark A Waghorm | Russell JW Wame District of North Vancouver W > Crompton BE McCrea R Clark PA White MUNICIPAL REPRESENTATIVES Ald (1) Blackburn Mayor Jb Laoucks Mayor M- Baker PROVINCIAL GOVERNMENT KEPRESE NIA TIVE JK Kevacghit AUXILIARY REPRESENTATIVE A Wilson MED AL STARP REPKE SE NTA TIVES € diet oof Sotatt President of Stott [oy Wo Panikrats Dor Prachefte corrites EXECUTIVE STARE OF LIONS GATE HOSPITAL Jobin Wo Borthrwte hk brave bt CoD ell I>r James Wo (Corbett Joye MC .ampbell Tom b> McMillan Csetry A) Martins Administrator Associate Adnmunistraten Merc al Coordinate Assttant Admimatratar Assistant Administrator Assistant Administrater STATISTICS 1979 1984 BEDS .- Set up at end of fiscal year Acute 456 412 ECU 169 169 Total (excluding bassinets) 625 581 Newborn 36 36 INPATIENT ADMISSIONS Acute 15,066 14,204 Long Term Care — 201 © Discharge Planning —_ 65 Extended Care 74 77 Newborn 1,392 1,565 Total 16,532 16,112 PATIENT DAYS Acute 147,527 123,015 Long Term Care 9,313 Discharge Planning —_— 4,563 Extended Care 61,564 61,572 Newborn 8,251 8,228 Total 217,342 206,691 eee eee OCCUPANCY RATE - Based on average set up during fiscal year Acute 89% 91% Extended Care 100% 100% AVERAGE LENGTH OF STAY (days) Acute 98 8.9 Long Term Care — 45.9 Discharge Planning — 65.2 Extended Care 674.5 792.1 Newborn 59 5.6 EMERGENCY PATIENTS 44,365 44,802 PHARMACY (# of . prescriptions) 67,049 74,462 OUTPATIENTS * INPATIENTS * and Referred-in 1979 _1984 1979 1984 Laboratory (incl. Lab, EEG & EEG) - units 1,645,879 2,518,752 3,012,239 2,885,819 Imaging (Radiology, Nuclear Medicine and Ultrasoun dand Computerized Tomography) visits 30,618 34.722 19,746 28,709 Rehabilitation Medicine (Physical/Occupattonal Therapy) units 648 299 1,108,390 1,625,673 1,592,287 Surgical Procedures 2,746 6.142 8.792 7,338 Medical Day Care Visits 1.159 9 462 ~ Psychiatric Day/Night Care Visits 10.885 13.624 1979 1984 L»etary Meals B28 912 779 568 Therapeutic Diet Meals 97 B36 98 982 Laundry Pounds of binen Processed 9113937 710,344 Note Inpatients those patents admitted to a hospital bed Outpatients those pahents not admitted to a hospital bed but who have undergone a treatment or hagnostt( procedure at the hospital